Vol. 04 (Autumn/Winter 2016)

Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service explains how mobile solutions are transforming the work of community-based health teams | NHE

As the IT provider to Northamptonshire Healthcare NHS FT, LGSS has been involved in delivering mobile working solutions to a number of community-based health teams, including health visitors and district nurses, and for providing similar solutions in local government.

The trend towards delivering care closer to home to meet both patient aspirations, and the need to deliver savings through the reduction of estate, means that increasing levels of flexible working are being demanded across the NHS. If done successfully, mobile working can help to deliver the type of service that patients tell us they would like from their health service.

As with many IT services we’ve had a few attempts at delivering practical mobile working solutions, each based on and constrained by the technology available at the time. Prior to our latest deployment, we asked staff what they needed from a mobile device. Overwhelmingly, those who responded wanted:

A small form factor: There is plenty of other equipment a district nurse needs to carry so devices need to be small, as light as possible and certainly no more awkward to carry than the files of paper notes previously used

Sufficient battery life to get through an entire working day

A fast start-up: Ensuring that as little of the precious contact time with the patient was spent waiting for the technology

Versatility: Multiple means of inputting data, suggesting the need for both touchscreen and keyboard input

It is estimated that 1:10 patients in health care sustain harm that is potentially avoidable and which often highlight system errors that were not appreciated | Faculty of Intensive Care Medicine

Investigation results in the identification of these system errors and the generation of solutions to prevent future incidents. Sharing and implementing these lessons improves patient safety.

National Patient Safety Alerts relevant to intensive care

National alerts are produced in response to analysis of centrally reported patient safety incidents. Details of all alerts may be found on the Central Alerting System website (https://www.cas.dh.gov.uk/Home.aspx).

Lessons from adverse incidents

Lessons from local incidents may not be shared widely and to improve wider patient safety, the Joint Standards Committee of the Faculty and the Intensive Care Society has created this forum to allow lessons from local investigations into adverse incidents to be disseminated to the intensive care community.

We welcome you to share important safety lessons that have occurred in your own departments that may have general relevance. Please use the form below (or your local form if you would prefer) to submit an anonymised summary of the incident, the learning arising and any changes that have been implemented to prevent future a reoccurrence.

Researchers have developed a new tool to help avoid adverse reactions to medicines | ScienceDaily

Previous research at Alder Hey found that three out of every 100 children admitted to hospital experience an ADR due to a medicine taken at home. 22% of these ADRs might have been avoidable. Examples of ADRs which were avoidable included: diarrhea with antibiotics, and constipation with medicines given to relieve pain and vomiting related to chemotherapy.

The team also found that around 1 in 6 children experienced at least one ADR whilst in hospital, which is similar to findings in adults. More than half of the ADRs seen in children in hospital were due to medicines used in general anaesthesia and for the treatment of pain after surgery.

Most of the ADRs were not severe and resolved soon after the medicine was stopped. The five most common ADRs seen were nausea and/or vomiting, itching, constipation, diarrhea and sleepiness.

A core component of NHS England’s Five Year Forward View (5YFV), which underpinned the subsequent financial settlement agreed with the Government, was that NHS productivity would improve by 2.4% a year for each of the five years up to 2020/21. The 5YFV went further suggesting that its implementation could even result in sustained improvements of 3% a year in the longer term, a proposition which must have assumed sustained improvement in workforce productivity, given that staff costs make up some 70% of NHS expenditure. This proposition always looked ambitious and subsequent analyses of the NHS’s long-term productivity performance have served to underline the size of the challenge. However the Carter Review, published 12 months ago, underlined the scale of the potential improvements that could be made in the NHS’s dominant acute sector.

A key contributor to achieving the rate of productivity improvement underpinning the 5FYV, reinforced by Carter’s conclusions, was the adoption of new digital technologies. This faith in the impact of digital technology is despite the evidence of the last 20 years that would cast considerable doubt as to the productivity impact of the digital technologies programmes that the NHS in England and its predecessors have implemented.

An analysis of current performance and future plans at the national, Sustainability and Transformation Plan and trust level suggests that the NHS as a system gives little priority to productivity improvement. Furthermore current plans for the development and implementation of digital technologies are unlikely to have any significant impact on productivity, certainly within the lifetime of the 5YFV.